The diverging role of embodiment in altered eating behaviors: a comparison between patients with anorexia nervosa and gender dysphoria

PURPOSE: Clinical studies describe a higher risk in individuals with Gender Dysphoria (GD) to engage in disordered eating practices, as well as dietary restraint. To the present day, clinical assessments on eating psychopathology in GD are principally oriented towards assessing behaviors, rather than the lived experience underlying these behaviors. METHODS: A sample of 141 individuals with GD (40 assigned male at birth-AMAB, 101 assigned female-AFAB), 153 individuals from the general population and 294 patients with AN were enrolled. Body Uneasiness Test (BUT), the Eating Disorders Examination Questionnaire (EDE) and the Identity and Eating Disorders questionnaire (IDEA) were administered. Analysis of variance and linear models were employed to estimate group differences, adjusted for age, education, and body mass index. RESULTS: Body uneasiness (BUT global severity index: F value 47.44, p < 0.001), and eating behaviors (EDE total score: F value 66.19, p < 0.001) lied on a spectrum of severity between patients with AN (highest), individuals with GD (elevated) and the general population. Patients with AN reported markedly greater embodiment disturbances in comparison with both the general population and AMAB or AFAB individuals with GD (IDEA total score: minimum T value 4.03, p < 0.001). However, AMAB individuals with GD also reported moderate embodiment disturbances in comparison with the general population (IDEA total score: T value 3.41, p < 0.01). DISCUSSION: Lived experiences may better highlight core differences between GD and clinical populations of patients with eating disorders. Embodiment disturbances were also reported by AMAB individuals, suggesting a role for gendered expectations in embodiment. LEVEL OF EVIDENCE: III, evidence obtained from cohort or case-control analytic studies.